New data from a study conducted at thrombectomy-capable stroke centers suggests that the benefit of combining thrombolysis with thrombectomy versus thrombectomy alone depends on time and is significant only when thrombolysis is administered shortly after symptom onset.
Presented on February 7, 2024, at the International Stroke Conference 2024 in Phoenix, Arizona, and simultaneously published online in JAMA, the findings reveal that the combination of thrombolysis and thrombectomy resulted in a favorable shift in functional outcome at 90 days compared to thrombectomy alone when thrombolysis was administered within 2 hours and 20 minutes of symptom onset. Beyond this timeframe, the association was no longer statistically significant.
The researchers, led by Johannes Kaesmacher, MD, University Hospital Bern, Switzerland, emphasized the importance of considering the time between symptom onset and expected thrombolysis administration when deciding whether to administer thrombolysis to patients undergoing thrombectomy.
While guidelines currently recommend administering thrombolysis before thrombectomy in eligible patients with large-vessel anterior circulation stroke, previous data on this treatment strategy have been inconclusive. The researchers aimed to address this uncertainty by conducting an individual participant data meta-analysis from six randomized clinical trials.
Results showed a significant interaction between the time from symptom onset to expected thrombolysis administration and the association of treatment allocation with functional outcomes. The benefit of thrombolysis plus thrombectomy diminished with longer delays in thrombolysis administration, highlighting the importance of timely intervention.
The authors noted that while some patients may benefit from combined thrombolysis and thrombectomy, others may not, and time from stroke onset to treatment is a crucial factor influencing outcomes. They estimated that up to approximately 50% of eligible patients undergoing thrombectomy may receive thrombolysis despite uncertain benefits according to the study's findings.
In conclusion, these results provide valuable insights for clinicians considering the administration of thrombolysis before thrombectomy in patients with acute ischemic stroke. Further validation of these findings can help stratify patient cohorts and optimize treatment strategies for better outcomes.